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EP0637440B1 - Interbody implant for the spine - Google Patents

Interbody implant for the spine Download PDF

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Publication number
EP0637440B1
EP0637440B1 EP94420224A EP94420224A EP0637440B1 EP 0637440 B1 EP0637440 B1 EP 0637440B1 EP 94420224 A EP94420224 A EP 94420224A EP 94420224 A EP94420224 A EP 94420224A EP 0637440 B1 EP0637440 B1 EP 0637440B1
Authority
EP
European Patent Office
Prior art keywords
implant
implant according
external
peripheral wall
wall
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP94420224A
Other languages
German (de)
French (fr)
Other versions
EP0637440A1 (en
Inventor
Jean Godefroy
Claude Laville
Raymond Roy-Camille
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Advanced Technical Fabrication SA
Original Assignee
Advanced Technical Fabrication SA
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Advanced Technical Fabrication SA filed Critical Advanced Technical Fabrication SA
Publication of EP0637440A1 publication Critical patent/EP0637440A1/en
Application granted granted Critical
Publication of EP0637440B1 publication Critical patent/EP0637440B1/en
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

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    • AHUMAN NECESSITIES
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    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02Prostheses implantable into the body
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    • A61F2/44Joints for the spine, e.g. vertebrae, spinal discs
    • A61F2/4455Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages
    • A61F2/446Joints for the spine, e.g. vertebrae, spinal discs for the fusion of spinal bodies, e.g. intervertebral fusion of adjacent spinal bodies, e.g. fusion cages having a circular or elliptical cross-section substantially parallel to the axis of the spine, e.g. cylinders or frustocones
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    • A61F2/4611Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor for insertion or extraction of endoprosthetic joints or of accessories thereof of spinal prostheses
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    • A61F2002/30537Special structural features of bone or joint prostheses not otherwise provided for adjustable
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    • A61F2002/3054Special structural features of bone or joint prostheses not otherwise provided for adjustable for adjusting angular orientation about a connection axis or implantation axis for selecting any one of a plurality of radial orientations between two modular parts, e.g. Morse taper connections, at discrete positions, angular positions or continuous positions
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0039Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in diameter
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0097Visible markings, e.g. indicia

Definitions

  • the present invention relates to hollow tubular intersomatic implants for stabilization of the spine, intended to form a wedge to be inserted into prepared grooves in the plates facing two neighboring vertebrae, so as to maintain a constant disc space.
  • Such a hollow tubular interbody implant is described for example in document US-A-4,501,269. It comprises an internal cavity delimited by a peripheral wall open at least at one first end, upper and lower openings ensuring communication between the external space and the internal space of the implant, and allowing direct contact between the vertebral plates and a cancellous bone graft inserted in the implant. This produces an intersomatic vertebral graft.
  • Another embodiment, described in document WO-A-89 12431, is a hollow cylindrical cage comprising holes distributed over its external surface of circular section and also comprising an external helical thread to allow its screwing.
  • Document EP-A-0 307 241 describes another example of an implant in the form of a parallelepiped cage.
  • the longitudinal edges of such a cage may damage the spinal cord or the roots when the implant is inserted between the adjacent vertebrae.
  • An implant is also known in the form of a cylindrical cage delimited by four uprights connecting two end faces of the cage, the uprights being oriented parallel to the opposite faces of the vertebrae.
  • Such an implant proves ineffective in restoring an anatomical lordosis, in particular because of the too low mechanical rigidity of its structure.
  • the problem proposed by the present invention is to define a new interbody implant structure which makes it possible to very substantially reduce the risks of nerve damage during installation, which makes it possible to ensure better positioning and better rotation blocking of the implant between the vertebrae, and which provides improved mechanical strength and good bone bonding to facilitate fusion between two adjacent vertebrae.
  • Another problem which the invention proposes to solve is the correction of the intervertebral angle, by giving the implant a particular shape making it possible to find an anatomical lumbar spinal lordosis.
  • interbody implant according to the invention is as defined in claim 1.
  • the peripheral wall further comprises at least one external anti-rotation relief intended to become embedded in the bone of a vertebra to oppose the rotation of the implant around its longitudinal axis.
  • the peripheral wall has a general truncated cone or ovoid shape with truncated longitudinal ends, the large base of which is formed by the face of the first end and the small base of which is formed by the face of the second end.
  • the external surfaces of the lateral faces have a flat, and said lateral faces are devoid of annular external ribs.
  • the interbody implant according to the invention is a hollow tubular element having a longitudinal axis II, made for example of metal or rigid synthetic material, comprising an internal cavity 1 delimited by a peripheral wall 2 open at least at a first end 3.
  • the peripheral wall 2 comprises an external surface 4 of generally circular section.
  • This external surface 4 is composed of two solid side faces 5 and 6 and of two respective upper 7 and lower 8 faces provided with communication lights.
  • the upper face 7 is provided with two communication lights 9 and 10
  • the lower face 8 being provided with two communication lights 11 and 12.
  • the peripheral wall 2 also comprises at least one annular external anti-recoil rib such that the rib 13 adjacent to the first end 3.
  • the implant comprises a first annular external rib 13 in the vicinity of its first end 3, a second annular external rib 14 in the vicinity of its second end 15, and an intermediate annular external rib 16 formed in an area intermediate 17 of peripheral wall 2 devoid of communication light.
  • the annular external ribs 13, 14 and 16 are toothed, in order to oppose both the axial translation and the rotation of the implant, the teeth becoming encrusted in the vertebral plates.
  • one or more longitudinal ribs projecting from the external surface of the peripheral wall 2 can be provided. These anti-rotation means are however more difficult to produce than the teeth of annular external ribs.
  • the communication lights 9, 10, 11 and 12 advantageously have an oblong shape, of length only slightly less than the half-length of the implant, of width substantially equal to the diameter of the implant.
  • an implant according to the invention may comprise one, two or three ribs, or a greater number of annular external ribs.
  • each annular external rib 13, 14 or 16 has an asymmetrical sawtooth cross section opposing the displacement of the implant in the direction of the second end 15.
  • the peripheral wall 2 has a generally external truncated cone shape whose large base is formed by the face of the first end 3 and whose small base is formed by the second end face 15. Such a shape makes it possible to restore and maintain the appropriate physiological angle between two adjacent vertebrae.
  • the peripheral wall 2 has a general external ovoid shape with truncated longitudinal ends forming a large base at the first end 3 and a small base at the second end 15.
  • the ovoid shape is chosen so as to more closely match the anatomical shape of the vertebral plates between which the implant is inserted. Before insertion of the implant, the grooves are then given a suitable longitudinal profile.
  • the lateral faces 5 and 6 are devoid of peripheral external ribs. Consequently, as can be seen more clearly in FIGS. 4 and 9, the annular external ribs are interrupted in line with each lateral face 5 or 6.
  • the peripheral rib 16 has two respective upper interruptions 18 and 19, and two interruptions respective lower 20 and 21, which oppose the rotation of the implant when it is engaged between two adjacent vertebrae.
  • the external surfaces of the lateral faces 5 and 6 may comprise a flat, as shown in FIGS. 1, 4, 6 and 9, which makes it possible to somewhat reduce the amount of material constituting the implant.
  • the flat occupies the entire length of the corresponding lateral face.
  • the peripheral wall 2 is connected, at its second end 15, to a transverse support wall 22.
  • This transverse support wall 22 includes an axial hole 23 threaded, allowing the adaptation of a laying tool in extension of the 'implant.
  • the transverse support wall 22 further comprises external reliefs, for example a diametrical groove or slot 24, making it possible to secure in rotation an instrument for placing on the implant.
  • the external reliefs are shaped so as to constitute in themselves a means of visual location of the angular position of the implant around its longitudinal axis I-I.
  • An external relief structure in the form of a groove or diametrical slot is suitable for constituting such a means of visual location of angular position.
  • FIGS. 3, 4, 5 and 9 represent an implant according to the invention in position between two adjacent vertebrae 25 and 26.
  • a spongy bone graft 100 taken from another part of the patient's body is introduced into its internal cavity 1.
  • a groove of appropriate section is made in the respective plates of each vertebra oriented sagittally with respect to the longitudinal axis of the spine, the assembly of the two grooves substantially forming a cylindrical housing, the section corresponds substantially to the dimension of the second end 15 of the implant.
  • the two vertebrae 25 and 26 are then moved aside by appropriate means, and the implant is inserted axially in the two grooves, then the vertebrae are released.
  • the truncated cone shape of the implant gives the vertebrae 25 and 26 an appropriate angulation, reproducing the normal morphological angle such as the anatomical lumbar lordosis.
  • the annular external ribs 13, 14 and 16 engage in the bone forming the vertebrae 25 and 26, and prevent axial movement of the insert.
  • the ends 18 to 21 of the annular external ribs, as well as the teeth or longitudinal ribs, bearing on the bone also prevent the rotation of the insert around its longitudinal axis.
  • the cancellous bone graft 100 is in contact with the bone of the lower 25 and upper 26 vertebrae, so as to gradually ensure the fusion of the vertebrae to one another.
  • the large size of the communication lights 9, 10, 11 and 12 promotes this fusion, by ensuring good contact between the internal graft 100 and the bone of the two vertebrae 25 and 26.
  • the solid lateral faces 5 and 6 of the insert according to the invention ensure good rigidity of the insert, to take up the compressive forces between the two vertebrae 25 and 26.
  • the generally circular section of the insert avoids the risk of neurological damage during the insertion of the insert between the two vertebrae.

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  • General Health & Medical Sciences (AREA)
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Abstract

The implant is tubular and hollow in shape and has an inner cavity (1) bounded by a peripheral wall (2) with communicating apertures (9-12). The wall has an outer surface (4) which is generally circular in shape, two solid side faces (5, 6), and upper and lower surfaces (7, 8) which have the apertures in them. The implant's outer surface has at least one anti-recoil rib (13). The implant's outer wall (2) has the general shape of a truncated cone or ovoid with its larger base situated at its first end (3), and it has outer annular ribs (13, 14, 17) at each end and in the middle, one or more of which can be toothed.

Description

La présente invention concerne les implants intersomatiques tubulaires creux pour stabilisation de la colonne vertébrale, destinés à former une cale à insérer dans des rainures préparées dans les plateaux en vis-à-vis de deux vertèbres voisines, de façon à maintenir un espace discal constant.The present invention relates to hollow tubular intersomatic implants for stabilization of the spine, intended to form a wedge to be inserted into prepared grooves in the plates facing two neighboring vertebrae, so as to maintain a constant disc space.

Un tel implant intersomatique tubulaire creux est décrit par exemple dans le document US-A-4 501 269. Il comprend une cavité interne délimitée par une paroi périphérique ouverte au moins à une première extrémité, des ouvertures supérieures et inférieures assurant une communication entre l'espace extérieur et l'espace intérieur de l'implant, et permettant le contact direct entre les plateaux vertébraux et un greffon d'os spongieux inséré dans l'implant. On réalise ainsi une greffe vertébrale intersomatique.Such a hollow tubular interbody implant is described for example in document US-A-4,501,269. It comprises an internal cavity delimited by a peripheral wall open at least at one first end, upper and lower openings ensuring communication between the external space and the internal space of the implant, and allowing direct contact between the vertebral plates and a cancellous bone graft inserted in the implant. This produces an intersomatic vertebral graft.

Une autre réalisation, décrite dans le document WO-A-89 12431, est une cage cylindrique creuse comportant des trous répartis sur sa surface externe de section circulaire et comportant également un filet hélicoïdal externe pour permettre son vissage.Another embodiment, described in document WO-A-89 12431, is a hollow cylindrical cage comprising holes distributed over its external surface of circular section and also comprising an external helical thread to allow its screwing.

Ces dispositifs s'avèrent inefficaces pour assurer une bonne soudure entre deux vertèbres successives, car la dimension des trous est nécessairement limitée, et le blocage en rotation est insuffisant.These devices prove to be ineffective in ensuring a good weld between two successive vertebrae, because the dimension of the holes is necessarily limited, and the rotation lock is insufficient.

Le document EP-A-0 307 241 décrit un autre exemple d'implant sous forme d'une cage parallélépipédique. Les arêtes longitudinales d'une telle cage risquent de léser la moelle épinière ou les racines lors de l'insertion de l'implant entre les vertèbres adjacentes.Document EP-A-0 307 241 describes another example of an implant in the form of a parallelepiped cage. The longitudinal edges of such a cage may damage the spinal cord or the roots when the implant is inserted between the adjacent vertebrae.

On connaît également un implant sous forme d'une cage cylindrique délimitée par quatre montants reliant deux faces extrêmes de la cage, les montants étant orientés parallèlement aux faces opposées des vertèbres. Un tel implant s'avère inefficace pour redonner une lordose anatomique, notamment à cause de la trop faible rigidité mécanique de sa structure.An implant is also known in the form of a cylindrical cage delimited by four uprights connecting two end faces of the cage, the uprights being oriented parallel to the opposite faces of the vertebrae. Such an implant proves ineffective in restoring an anatomical lordosis, in particular because of the too low mechanical rigidity of its structure.

Le problème proposé par la présente invention est de définir une nouvelle structure d'implant intersomatique qui permette de réduire très sensiblement les risques de lésions nerveuses lors de la pose, qui permette d'assurer un meilleur positionnement et un meilleur blocage en rotation de l'implant entre les vertèbres, et qui assure une résistance mécanique améliorée et un bon accrochage osseux pour faciliter la fusion entre deux vertèbres adjacentes.The problem proposed by the present invention is to define a new interbody implant structure which makes it possible to very substantially reduce the risks of nerve damage during installation, which makes it possible to ensure better positioning and better rotation blocking of the implant between the vertebrae, and which provides improved mechanical strength and good bone bonding to facilitate fusion between two adjacent vertebrae.

Un autre problème que se propose de résoudre l'invention est la correction de l'angle intervertébral, en donnant à l'implant une forme particulière permettant de retrouver une lordose rachidienne lombaire anatomique.Another problem which the invention proposes to solve is the correction of the intervertebral angle, by giving the implant a particular shape making it possible to find an anatomical lumbar spinal lordosis.

Pour atteindre ces objets ainsi que d'autres, l'implant intersomatique selon l'invention est tel que défini dans la revendication 1.To achieve these and other objects, the interbody implant according to the invention is as defined in claim 1.

Selon une réalisation préférée, la paroi périphérique comprend en outre au moins un relief externe anti-rotation destiné à s'incruster dans l'os d'une vertèbre pour s'opposer à la rotation de l'implant autour de son axe longitudinal.According to a preferred embodiment, the peripheral wall further comprises at least one external anti-rotation relief intended to become embedded in the bone of a vertebra to oppose the rotation of the implant around its longitudinal axis.

De préférence, la paroi périphérique présente une forme générale en tronc de cône ou en ovoïde à extrémités longitudinales tronquées, dont la grande base est constituée par la face de première extrémité et dont la petite base est constituée par la face de seconde extrémité.Preferably, the peripheral wall has a general truncated cone or ovoid shape with truncated longitudinal ends, the large base of which is formed by the face of the first end and the small base of which is formed by the face of the second end.

Selon un mode de réalisation avantageux, les surfaces externes des faces latérales comportent un méplat, et lesdites faces latérales sont dépourvues de nervures externes annulaires.According to an advantageous embodiment, the external surfaces of the lateral faces have a flat, and said lateral faces are devoid of annular external ribs.

D'autres objets, caractéristiques et avantages de la présente invention ressortiront de la description suivante de modes de réalisation particuliers, faite en relation avec les figures jointes, parmi lesquelles:

  • la figure 1 est une vue en perspective de trois quart et de dessus d'un implant intersomatique selon un mode de réalisation de la présente invention ;
  • la figure 2 est une vue de dessus de l'implant de la figure 1 ;
  • la figure 3 est une vue de côté en coupe longitudinale montrant un implant de la figure 1 en position entre deux vertèbres ;
  • la figure 4 est une coupe transversale selon le plan A-A de la figure 3 ;
  • la figure 5 est une vue de côté en coupe longitudinale montrant un implant à forme générale en ovoïde à extrémités longitudinales tronquées ;
  • la figure 6 est une vue en perspective de trois quart et de dessus d'un implant selon un second mode de réalisation de l'invention
  • la figure 7 est une vue de dessus de l'implant de la figure 6 ;
  • la figure 8 est une coupe longitudinale de l'implant de la figure 6 ; et
  • la figure 9 est une coupe transversale de l'implant de la figure 6.
Other objects, characteristics and advantages of the present invention will emerge from the following description of particular embodiments, given in relation to the attached figures, among which:
  • Figure 1 is a three-quarter perspective view from above of an interbody implant according to an embodiment of the present invention;
  • Figure 2 is a top view of the implant of Figure 1;
  • Figure 3 is a side view in longitudinal section showing an implant of Figure 1 in position between two vertebrae;
  • Figure 4 is a cross section along the plane AA of Figure 3;
  • FIG. 5 is a side view in longitudinal section showing an implant of general ovoid shape with truncated longitudinal ends;
  • Figure 6 is a three-quarter perspective view from above of an implant according to a second embodiment of the invention
  • Figure 7 is a top view of the implant of Figure 6;
  • Figure 8 is a longitudinal section of the implant of Figure 6; and
  • FIG. 9 is a cross section of the implant of FIG. 6.

Comme le représentent les figures, l'implant intersomatique selon l'invention est un élément tubulaire creux présentant un axe longitudinal I-I, réalisé par exemple en métal ou en matériau synthétique rigide, comprenant une cavité interne 1 délimitée par une paroi périphérique 2 ouverte au moins à une première extrémité 3.As shown in the figures, the interbody implant according to the invention is a hollow tubular element having a longitudinal axis II, made for example of metal or rigid synthetic material, comprising an internal cavity 1 delimited by a peripheral wall 2 open at least at a first end 3.

La paroi périphérique 2 comprend une surface externe 4 à section généralement circulaire. Cette surface externe 4 se compose de deux faces latérales 5 et 6 pleines et de deux faces respectives supérieure 7 et inférieure 8 munies de lumières de communication. Par exemple, la face supérieure 7 est munie de deux lumières de communication 9 et 10, la face inférieure 8 étant munie de deux lumières de communication 11 et 12.The peripheral wall 2 comprises an external surface 4 of generally circular section. This external surface 4 is composed of two solid side faces 5 and 6 and of two respective upper 7 and lower 8 faces provided with communication lights. For example, the upper face 7 is provided with two communication lights 9 and 10, the lower face 8 being provided with two communication lights 11 and 12.

La paroi périphérique 2 comprend en outre au moins une nervure externe annulaire anti recul telle que la nervure 13 voisine de la première extrémité 3.The peripheral wall 2 also comprises at least one annular external anti-recoil rib such that the rib 13 adjacent to the first end 3.

Dans les modes de réalisation représentés, l'implant comprend une première nervure externe annulaire 13 au voisinage de sa première extrémité 3, une seconde nervure externe annulaire 14 au voisinage de sa seconde extrémité 15, et une nervure externe annulaire intermédiaire 16 ménagée sur une zone intermédiaire 17 de paroi périphérique 2 dépourvue de lumière de communication.In the embodiments shown, the implant comprises a first annular external rib 13 in the vicinity of its first end 3, a second annular external rib 14 in the vicinity of its second end 15, and an intermediate annular external rib 16 formed in an area intermediate 17 of peripheral wall 2 devoid of communication light.

De préférence, comme illustré dans le mode de réalisation représenté sur les figures 6 à 9, les nervures externes annulaires 13, 14 et 16 sont dentées, pour s'opposer à la fois à la translation axiale et à la rotation de l'implant, les dents venant s'incruster dans les plateaux vertébraux.Preferably, as illustrated in the embodiment shown in FIGS. 6 to 9, the annular external ribs 13, 14 and 16 are toothed, in order to oppose both the axial translation and the rotation of the implant, the teeth becoming encrusted in the vertebral plates.

En alternative, on peut prévoir une ou plusieurs nervures longitudinales faisant saillie sur la surface externe de la paroi périphérique 2. Ces moyens anti-rotation sont toutefois plus difficiles à réaliser que les dents de nervures externes annulaires.Alternatively, one or more longitudinal ribs projecting from the external surface of the peripheral wall 2 can be provided. These anti-rotation means are however more difficult to produce than the teeth of annular external ribs.

Dans tous les modes de réalisation, les lumières de communication 9, 10, 11 et 12 ont avantageusement une forme oblongue, de longueur seulement peu inférieure à la demi-longueur de l'implant, de largeur sensiblement égale au diamètre de l'implant.In all the embodiments, the communication lights 9, 10, 11 and 12 advantageously have an oblong shape, of length only slightly less than the half-length of the implant, of width substantially equal to the diameter of the implant.

On comprendra qu'un implant selon l'invention peut comprendre une, deux ou trois nervures, ou un nombre plus important de nervures externes annulaires.It will be understood that an implant according to the invention may comprise one, two or three ribs, or a greater number of annular external ribs.

De préférence, comme le représentent notamment les figures 3, 5 et 8, chaque nervure externe annulaire 13, 14 ou 16 présente une section transversale en dent de scie asymétrique s'opposant au déplacement de l'implant en direction de la seconde extrémité 15.Preferably, as shown in particular in FIGS. 3, 5 and 8, each annular external rib 13, 14 or 16 has an asymmetrical sawtooth cross section opposing the displacement of the implant in the direction of the second end 15.

Dans les modes de réalisation des figures 1 à 3 et 6 à 8, la paroi périphérique 2 présente une forme générale externe en tronc de cône dont la grande base est constituée par la face de première extrémité 3 et dont la petite base est constituée par la face de seconde extrémité 15. Une telle forme permet de redonner et de maintenir l'angle physiologique approprié entre deux vertèbres adjacentes.In the embodiments of FIGS. 1 to 3 and 6 to 8, the peripheral wall 2 has a generally external truncated cone shape whose large base is formed by the face of the first end 3 and whose small base is formed by the second end face 15. Such a shape makes it possible to restore and maintain the appropriate physiological angle between two adjacent vertebrae.

Dans le mode de réalisation de la figure 5, la paroi périphérique 2 présente une forme générale externe en ovoïde à extrémités longitudinales tronquées formant une grande base à la première extrémité 3 et une petite base à la seconde extrémité 15.In the embodiment of FIG. 5, the peripheral wall 2 has a general external ovoid shape with truncated longitudinal ends forming a large base at the first end 3 and a small base at the second end 15.

La forme ovoïde est choisie de façon à épouser plus étroitement la forme anatomique des plateaux vertébraux entre lesquels l'implant vient s'insérer. Avant insertion de l'implant, on donne alors aux rainures un profil longitudinal adapté.The ovoid shape is chosen so as to more closely match the anatomical shape of the vertebral plates between which the implant is inserted. Before insertion of the implant, the grooves are then given a suitable longitudinal profile.

Dans les modes de réalisation représentés, les faces latérales 5 et 6 sont dépourvues de nervures externes périphériques. En conséquence, comme on le voit mieux sur les figures 4 et 9, les nervures externes annulaires sont interrompues au droit de chaque face latérales 5 ou 6. Par exemple, la nervure périphérique 16 comporte deux interruptions supérieures respectives 18 et 19, et deux interruptions inférieures respectives 20 et 21, qui s'opposent à la rotation de l'implant lorsque celui-ci est engagé entre deux vertèbres adjacentes.In the embodiments shown, the lateral faces 5 and 6 are devoid of peripheral external ribs. Consequently, as can be seen more clearly in FIGS. 4 and 9, the annular external ribs are interrupted in line with each lateral face 5 or 6. For example, the peripheral rib 16 has two respective upper interruptions 18 and 19, and two interruptions respective lower 20 and 21, which oppose the rotation of the implant when it is engaged between two adjacent vertebrae.

Les surfaces externes des faces latérales 5 et 6 peuvent comprendre un méplat, comme représenté sur les figures 1, 4, 6 et 9, ce qui permet de réduire quelque peu la quantité de matière constituant l'implant. Le méplat occupe toute la longueur de la face latérale correspondante.The external surfaces of the lateral faces 5 and 6 may comprise a flat, as shown in FIGS. 1, 4, 6 and 9, which makes it possible to somewhat reduce the amount of material constituting the implant. The flat occupies the entire length of the corresponding lateral face.

La paroi périphérique 2 se raccorde, à sa seconde extrémité 15, à une paroi transversale d'appui 22. Cette paroi transversale d'appui 22 comprend un trou axial 23 taraudé, permettant l'adaptation d'un outil de pose en prolongement de l'implant.The peripheral wall 2 is connected, at its second end 15, to a transverse support wall 22. This transverse support wall 22 includes an axial hole 23 threaded, allowing the adaptation of a laying tool in extension of the 'implant.

La paroi transversale d'appui 22 comprend en outre des reliefs externes, par exemple une rainure ou fente diamétrale 24, permettant de solidariser en rotation un instrument de pose sur l'implant.The transverse support wall 22 further comprises external reliefs, for example a diametrical groove or slot 24, making it possible to secure in rotation an instrument for placing on the implant.

De préférence, les reliefs externes sont conformés de façon à constituer en eux-mêmes un moyen de repérage visuel de position angulaire de l'implant autour de son axe longitudinal I-I. Une structure de relief externe en forme de rainure ou fente diamétrale convient pour constituer un tel moyen de repérage visuel de position angulaire. Cela permet en particulier de positionner l'implant entre deux vertèbres de façon que les faces supérieure 7 et inférieure 8 soit en regard des faces correspondantes des deux vertèbres adjacentes entre lesquelles l'implant est engagé.Preferably, the external reliefs are shaped so as to constitute in themselves a means of visual location of the angular position of the implant around its longitudinal axis I-I. An external relief structure in the form of a groove or diametrical slot is suitable for constituting such a means of visual location of angular position. This makes it possible in particular to position the implant between two vertebrae so that the upper 7 and lower 8 faces are opposite the corresponding faces of the two adjacent vertebrae between which the implant is engaged.

Les figures 3, 4, 5 et 9 représentent un implant selon l'invention en position entre deux vertèbres adjacentes 25 et 26.FIGS. 3, 4, 5 and 9 represent an implant according to the invention in position between two adjacent vertebrae 25 and 26.

Préalablement à la pose de l'insert, on introduit dans sa cavité interne 1 un greffon d'os spongieux 100 prélevé dans une autre partie du corps du patient.Prior to the insertion of the insert, a spongy bone graft 100 taken from another part of the patient's body is introduced into its internal cavity 1.

Avant d'engager l'implant entre les deux vertèbres, on réalise dans les plateaux respectifs de chaque vertèbre une rainure de section appropriée orientée sagittalement par rapport à l'axe longitudinal du rachis, l'ensemble des deux rainures formant sensiblement un logement cylindrique dont la section correspond sensiblement à la dimension de la seconde extrémité 15 de l'implant. On écarte ensuite les deux vertèbres 25 et 26 par des moyens appropriés, et l'on insère axialement l'implant dans les deux rainures, puis l'on relâche les vertèbres. La forme en tronc de cône de l'implant donne aux vertèbres 25 et 26 une angulation appropriée, reproduisant l'angle morphologique normal tel que la lordose lombaire anatomique. Les nervures externes annulaires 13, 14 et 16 s'engagent dans l'os formant les vertèbres 25 et 26, et interdisent le déplacement axial de l'insert. Les extrémités 18 à 21 des nervures externes annulaires, ainsi que les dents ou nervures longitudinales, en appui sur l'os empêchent également la rotation de l'insert autour de son axe longitudinal.Before engaging the implant between the two vertebrae, a groove of appropriate section is made in the respective plates of each vertebra oriented sagittally with respect to the longitudinal axis of the spine, the assembly of the two grooves substantially forming a cylindrical housing, the section corresponds substantially to the dimension of the second end 15 of the implant. The two vertebrae 25 and 26 are then moved aside by appropriate means, and the implant is inserted axially in the two grooves, then the vertebrae are released. The truncated cone shape of the implant gives the vertebrae 25 and 26 an appropriate angulation, reproducing the normal morphological angle such as the anatomical lumbar lordosis. The annular external ribs 13, 14 and 16 engage in the bone forming the vertebrae 25 and 26, and prevent axial movement of the insert. The ends 18 to 21 of the annular external ribs, as well as the teeth or longitudinal ribs, bearing on the bone also prevent the rotation of the insert around its longitudinal axis.

Après la pose, le greffon d'os spongieux 100 est en contact avec l'os des vertèbres inférieure 25 et supérieure 26, de façon à assurer progressivement la fusion des vertèbres l'une à l'autre. La taille importante des lumières de communication 9, 10, 11 et 12 favorise cette fusion, en assurant un bon contact entre le greffon interne 100 et l'os des deux vertèbres 25 et 26.After placement, the cancellous bone graft 100 is in contact with the bone of the lower 25 and upper 26 vertebrae, so as to gradually ensure the fusion of the vertebrae to one another. The large size of the communication lights 9, 10, 11 and 12 promotes this fusion, by ensuring good contact between the internal graft 100 and the bone of the two vertebrae 25 and 26.

Les faces latérales pleines 5 et 6 de l'insert selon l'invention assurent une bonne rigidité de l'insert, pour reprendre les efforts de compression entre les deux vertèbres 25 et 26.The solid lateral faces 5 and 6 of the insert according to the invention ensure good rigidity of the insert, to take up the compressive forces between the two vertebrae 25 and 26.

La section généralement circulaire de l'insert évite le risque de lésion neurologique lors de l'insertion de l'insert entre les deux vertèbres.The generally circular section of the insert avoids the risk of neurological damage during the insertion of the insert between the two vertebrae.

La présente invention n'est pas limitée aux modes de réalisation qui ont été explicitement décrits, mais elle en inclut les diverses variantes et généralisations contenues dans le domaine des revendications ci-après.The present invention is not limited to the embodiments which have been explicitly described, but it includes the various variants and generalizations thereof contained in the field of claims below.

Claims (12)

  1. Hollow tubular intersomatic implant for stabilization of the vertebral column, comprising an internal cavity (1) delimited by a peripheral wall (2) comprising a generally circular cross-section external surface (4) and having communicating holes (9, 10, 11, 12), characterized in that the external surface (4) is composed of two solid side surfaces (5, 6) and top (7) and bottom surfaces (8) having said communicating holes (9, 10, 11, 12) in them, and in that the peripheral wall comprises at least one annular external rib (13) that prevent retrograde movement that can be interrupted.
  2. Implant according to claim 1, characterized in that the peripheral wall (2) further comprises at least one rotation preventing external relief.
  3. Implant according to claim 1 or claim 2, characterized in that the peripheral wall (2) is generally frustoconical or ovoidal with truncated longitudinal ends the larger base of which consists of the surface at its first end (3).
  4. Implant according to any one of claims 1 to 3, characterized in that the peripheral wall (2) comprises a respective annular external rib (13, 14) near its first end (3) and near its second end (15).
  5. Implant according to claim 4, characterized in that it further comprises an intermediate annular external rib (16) in an intermediate area (17) of the wall in which there are no communicating holes.
  6. Implant according to claim 2, characterized in that said rotation preventing external relief comprises at least one tooth projecting from at least one of the annular external ribs (13) for preventing retrograde movement.
  7. Implant according to any one of claims 1 to 6, characterized in that the side surfaces (5, 6) have no annular external ribs.
  8. Implant according to any one of claims 1 to 7, characterized in that the side surfaces (5, 6) include a flat on their outside.
  9. Implant according to any one of claims 1 to 8, characterized in that the peripheral wall (2) is joined, at its second end (15), to a transverse bearing wall (22).
  10. Implant according to claim 9, characterized in that the transverse bearing wall (22) comprises a threaded axial hole (23) for fitting an inserting tool.
  11. Implant according to claim 10, characterized in that the transverse bearing wall (22) includes external reliefs (24) for preventing rotation of the inserting tool relative to the implant.
  12. Implant according to claim 11, characterized in that the external reliefs (24) are shaped to constitute means for visually indicating the angular position of the implant about its longitudinal axis (I-I).
EP94420224A 1993-08-06 1994-08-01 Interbody implant for the spine Expired - Lifetime EP0637440B1 (en)

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FR9309835A FR2708461B1 (en) 1993-08-06 1993-08-06 Interbody implant for spine.
FR9309835 1993-08-06

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EP0637440A1 EP0637440A1 (en) 1995-02-08
EP0637440B1 true EP0637440B1 (en) 1997-10-15

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EP (1) EP0637440B1 (en)
JP (1) JP2558438B2 (en)
KR (1) KR950005279A (en)
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AU (1) AU668654B2 (en)
CA (1) CA2128932C (en)
DE (1) DE69406216T2 (en)
FI (1) FI943640A (en)
FR (1) FR2708461B1 (en)
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DE69406216D1 (en) 1997-11-20
JPH07148189A (en) 1995-06-13
EP0637440A1 (en) 1995-02-08
CA2128932A1 (en) 1995-02-04
AU668654B2 (en) 1996-05-09
CA2128932C (en) 1998-08-25
ATE159167T1 (en) 1997-11-15
NZ264176A (en) 1996-10-28
AU6890094A (en) 1995-03-02
JP2558438B2 (en) 1996-11-27
FI943640A0 (en) 1994-08-05
FI943640A (en) 1995-02-07
TW267932B (en) 1996-01-11
DE69406216T2 (en) 1998-05-28
FR2708461A1 (en) 1995-02-10
FR2708461B1 (en) 1995-09-29
US5683463A (en) 1997-11-04
KR950005279A (en) 1995-03-20

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